Active NPI
Brooks Michael Whalen, PA
- Physician Assistant
- Saint Augustine, FL
National Provider Identifier
1245506799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9106470
- Practice address
- 130 Health Park Blvd
Saint Augustine, FL 32086 - Phone
- (904) 826-3469
- Fax
- (904) 808-4608
- NPI assigned
- Mar 29, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9106470 | FL | Primary |
Addresses
Primary practice location
130 Health Park Blvd
Saint Augustine, FL 32086
Mailing address
130 Health Park Blvd
Saint Augustine, FL 32086
Phone (904) 826-3469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332979200000",
"number": "1245506799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 HEALTH PARK BLVD",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "32086",
"telephone_number": "904-826-3469",
"fax_number": "904-808-4608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 HEALTH PARK BLVD",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "32086",
"telephone_number": "904-826-3469",
"fax_number": "904-808-4608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHALEN",
"first_name": "BROOKS",
"middle_name": "MICHAEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-29",
"last_updated": "2012-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9106470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.